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Shrivastava A, Jindal G, Khan L, Chaube R. A Rare Case of Cystic Artery Pseudoaneurysm because of Cholecystitis Managed with Non-invasive Technique. Middle East J Dig Dis 2023; 15:285-288. [PMID: 38523887 PMCID: PMC10955983 DOI: 10.34172/mejdd.2023.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/25/2023] [Indexed: 03/26/2024] Open
Abstract
Cystic artery pseudoaneurysm due to acute on chronic cholecystitis is very rare in spite of the high incidence of cholecystitis, and very few cases have been reported in the literature. Most of the pseudoaneurysms are symptomatic at the time of diagnosis due to rupture. Very few cases of unruptured cystic artery pseudoaneurysm caused by cholecystitis have been reported in the literature. We present a case of a 41-year-old man who presented in the Intervention Radiology Department with the diagnosis of cholecystitis and cystic artery pseudoaneurysm. Three treatment options are available for such cases. The first approach is surgical clipping of the pseudoaneurysm and cholecystectomy. The second approach is endovascular management of pseudoaneurysm and cholecystectomy. We chose the third approach, endovascular management of the pseudoaneurysm, percutaneous cholecystostomy, and elective laparoscopic cholecystectomy.
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Affiliation(s)
| | - Gunjan Jindal
- Department of Radiodiagnosis, MMIMSR, Mullana, Haryana, India
| | - Lukman Khan
- Department of Radiodiagnosis, MMIMSR, Mullana, Haryana, India
| | - Rohan Chaube
- Department of Radiodiagnosis, MMIMSR, Mullana, Haryana, India
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2
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Khan H, Lourdusamy V, Bansal R. Cystic Artery Pseudoaneurysm Secondary to Cholecystitis: A Rare Cause of Hemobilia. Cureus 2023; 15:e39161. [PMID: 37332406 PMCID: PMC10275746 DOI: 10.7759/cureus.39161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
Cystic artery pseudoaneurysm (CAP) is usually seen as a complication of cholecystectomy. Infrequently, CAP can develop in the setting of cholecystitis and can present as hemobilia when the aneurysm ruptures. Here, we present the case of an 88-year-old male with hemobilia secondary to CAP which was successfully managed by embolization after an initial biliary stent placement.
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Affiliation(s)
- Haidar Khan
- Internal Medicine, New York City Health + Hospitals/Elmhurst, New York City, USA
| | - Vennis Lourdusamy
- Gastroenterology, New York City Health + Hospitals/Elmhurst, New York City, USA
| | - Raghav Bansal
- Gastroenterology, New York City Health + Hospitals/Elmhurst, New York City, USA
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3
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Patidar Y, Chandel K, Chatterjee N, Tripathy TP, Kumar S. Cystic Artery Pseudoaneurysm with Concurrent Cholecystoduodenal Fistula—Endovascular Management and Review of Literature. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1745919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractA rare complication of acute cholecystitis is a pseudoaneurysm of the cystic artery. We discuss a case of a 65-year-old man with synchronous cholecystoenteric fistula and cystic artery pseudoaneurysm managed by selective angioembolization of the cystic artery, followed by interval cholecystectomy.
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Affiliation(s)
- Yashwant Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Karamvir Chandel
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Navojit Chatterjee
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Tara Prasad Tripathy
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Senthil Kumar
- Department of HPB Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
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4
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Christodoulou P, Liapis SC. Early Rupture of Iatrogenic Cystic Artery Pseudoaneurysm After Unsuccessful Laparoscopic Cholecystectomy: A Case Report. Cureus 2022; 14:e22865. [PMID: 35399467 PMCID: PMC8982512 DOI: 10.7759/cureus.22865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/24/2022] Open
Abstract
Laparoscopic cholecystectomy has been established as the gold-standard method to deal with symptomatic cholelithiasis and cholecystitis. Although, like any other surgical procedure, it may have complications that affect the mortality and morbidity of patients. More specifically, the cystic artery pseudoaneurysm is considered a rare complication of laparoscopic cholecystectomy, which despite its rarity, may be fatal for the patient. Herein, we present the case of a 67-year-old man with a ruptured iatrogenic cystic artery pseudoaneurysm in the early postoperative period after laparoscopic cholecystectomy that converted to open wherein a cholecystostomy catheter was placed. The patient was hospitalized in our surgical unit, and he was treated with cystic artery embolization initially and secondary with elective open cholecystectomy.
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5
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Zi’ang YBS, Xia XBS. Ultrasound of Pancreaticoduodenal Pseudoaneurysm without Obvious Cause, A Case Report. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.210029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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6
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Cystic Artery Pseudoaneurysm: Current Review of Aetiology, Presentation, and Management. Surg Res Pract 2021; 2021:4492206. [PMID: 34869829 PMCID: PMC8635945 DOI: 10.1155/2021/4492206] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background Cystic artery pseudoaneurysms are rare. Most commonly, they occur secondary to acute cholecystitis or after a cholecystectomy. Complications include haemobilia, biliary obstruction, and haemorrhage. Given the rarity and associated morbidity, a high index of suspicion is required. This article reviews the current literature on cystic artery pseudoaneurysms to investigate its aetiology, clinical presentation, and management options. Methods A broad search of the Medline and PubMed databases was carried through. All peer reviewed literatures published in the English language between 1991 and 2020 with keywords "cystic" and "artery" and "pseudoaneurysm" in the title were selected for review. No further exclusion criteria; all studies yielded from the search were included in the results of this review. Additionally, we present a case of cystic artery pseudoaneurysm treated at our centre and included this in our analysis. Results Sixty-seven case reports were found between 1991 and 2020. Aetiologies: Aetiology of cystic artery pseudoaneurysm was found to be cholecystitis in 41 instances (61.2%), cholecystectomy in 18 instances (26.8%), idiopathic in 6 instances (8.9%) cholelithiasis in 1 instance (1.5%), and pancreatitis in 1 instance (1.5%). Complications: Fifty-two cases were complicated by haemobilia (77.6%), 36 by anaemia (53.7%), 25 by biliary obstruction (37.3%), 13 by haemodynamic shock (19.4%), 9 by haemoperitoneum (13.4%), and 6 by contained rupture (8.9%). Most commonly, patients had two or more of these complications. Management: Forty-four patients were managed with endovascular embolisation (65.7%), 21 with endoscopic intervention (31.3%), 18 with open cholecystectomy (26.9%), 13 with laparoscopic cholecystectomy (19.4%), and 6 with pseudoaneurysm ligation (9%). Delayed presentation postcholecystectomy ranged from 8 days to 3 years. Conclusions Cystic artery pseudoaneurysms are rare complications of a common operation. The most common clinical presentation is haemobilia, which can be difficult to diagnose clinically. A high index of suspicion and prompt investigation with targeted imaging and intervention is required. This is especially pertinent in gastrointestinal bleeding postlaparoscopic cholecystectomy as a missed diagnosis could cause significant morbidity.
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7
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Patil NS, Kumar AH, Pamecha V, Gattu T, Falari S, Sinha PK, Mohapatra N. Cystic artery pseudoaneurysm-a rare complication of acute cholecystitis: review of literature. Surg Endosc 2021; 36:871-880. [PMID: 34811584 DOI: 10.1007/s00464-021-08796-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 10/17/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To acquaint with the presentation and management of the cystic artery aneurysm by enriching the reviewed literature with our own experience. BACKGROUND Cystic artery pseudoaneurysm is an uncommon entity with varied clinical presentation. Inflammation and trauma are associated with most of the cases. Limited experience with the condition challenges the management of individual cases. MATERIALS AND METHODS We retrieved all the reported cases of cystic artery pseudoaneurysm, published up to December 2019, from the PubMed database and excluded those arising as postoperative complications. A total of 59 cases were analyzed, and we also included our experience of managing a case of cystic artery pseudoaneurysm. RESULTS Abdominal pain (77.9%) was the most common presentation followed by upper GI bleed (64.4%), while 19 patients (32.2%) had presented with classic Quincke's Triad. Most of the cases were diagnosed following the rupture of the pseudoaneurysm (n = 49, 83.05%). Fifteen patients presented with shock. Hyperbilirubinemia (59.3%) and anemia (55.9%) were the commonest laboratory findings. Although CT angiogram remains the investigation of choice, a conventional angiogram is the gold standard and sufficed as the definitive management in 20 cases. Cholecystectomy formed the definitive management in the rest of the cases. We successfully managed a middle-aged female patient of cystic artery aneurysm with xanthogranulomatous cholecystitis by open cholecystectomy. CONCLUSION Cystic artery pseudoaneurysms are amenable to successful management with careful evaluation and timely cholecystectomy or angioembolization or a combination of both.
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Affiliation(s)
- Nilesh Sadashiv Patil
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Anubhav Harshit Kumar
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Viniyendra Pamecha
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India.
| | - Tharun Gattu
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Sanyam Falari
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Piyush Kumar Sinha
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
| | - Nihar Mohapatra
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India
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8
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Nguyen D, Goodwin JS, Bhowmik N, Boiteau G, Potts J. Acute Hemorrhagic Cholecystitis with Large Hemoperitoneum: Treatment with Microcoil Embolization and Subsequent Cholecystectomy. J Radiol Case Rep 2021; 15:25-34. [PMID: 33717408 DOI: 10.3941/jrcr.v15i2.3901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hemorrhagic cholecystitis is a potentially deadly and difficult to recognize entity. It is associated with cystic artery pseudoaneurysm and is usually seen in the setting of acute calculous cholecystitis. We report two cases of hemorrhagic cholecystitis with arteriographic findings of cystic artery pseudoaneurysms that were successfully embolized using microcoils, facilitating subsequent cholecystectomy. Both cases had unusual presentations of gallbladder rupture with hemoperitoneum, the latter of which was atypical occurring in the absence of gallstones. We believe when hemorrhagic cholecystitis is suspected, a two-step therapeutic approach should be employed with embolization of the bleeding cystic artery followed by cholecystectomy. A comprehensive literature review and discussion of hemorrhagic cholecystitis will be provided.
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Affiliation(s)
- Don Nguyen
- Department of Abdominal Imaging & Intervention, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - J Scott Goodwin
- Department of Diagnostic Radiology, Duke University Hospital, Durham, USA
| | - Nirjhor Bhowmik
- Department of Vascular & Interventional Radiology, Medical College of Wisconsin, Wauwatosa, USA
| | - Guillaume Boiteau
- Department of Vascular & Interventional Radiology, Allegheny Health Network, Pittsburgh, USA
| | - Jonathan Potts
- Department of Vascular & Interventional Radiology, Allegheny Health Network, Pittsburgh, USA
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9
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Traa AC, Hoven-Gondrie ML, Diederik AL. A pseudoaneurysm of the right hepatic artery treated successfully with a stent graft - A case report. Int J Surg Case Rep 2020; 77:407-411. [PMID: 33220658 PMCID: PMC7688995 DOI: 10.1016/j.ijscr.2020.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 10/27/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022] Open
Abstract
Haemobilia caused by pseudoaneurysms of the right hepatic artery or the cystic artery are rare with incidences up to 0.6%. Pathogenesis of pseudoaneurysms of the cystic or hepatic arteries are described to be cholecystectomy or cholecystitis related. Embolization is considered the golden standard. However, stent grafts should be considered a minimal invasive and effective alternative after failed embolization in pseudoaneurysms.
Introduction Haemobilia caused by pseudoaneurysms of the right hepatic or cystic artery is rare. Haemobilia classically causes gastro-intestinal hemorrhage, jaundice and upper abdominal pain. Presentation of case A 76-year old female underwent laparoscopic cholecystectomy because of a severe acute on chronic cholecystitis. A massive arterial bleeding occurred during surgery, which was controlled with hemoclips. Approximately one week after surgery the patient developed severe colic pains and cholestatic liver enzyme alterations. Endo-ultrasound showed normal-width bile ducts, however during a subsequent ERCP haemobilia was observed. On computed tomography a pseudoaneurysm of the right hepatic artery was seen. Selective embolization was initially successful, however, a rebleed was observed two weeks later and a 6 × 50 mm Viabahn stent graft was placed in the right hepatic artery uneventfully. The patient remained free of complaints during 3-years of follow-up. Discussion Pseudoaneurysms of the cystic or hepatic arteries are described to be cholecystectomy or cholecystitis related. The etiology of the pseudoaneurysm in this case can be inflammatory or iatrogenic. Embolization is the golden standard in pseudoaneurysm treatment. Stent graft implantation has not been frequently described as an alternative option to surgery after a failed attempt of embolization. Conclusion This case report presents a probable cholecystitis related pseudoaneurysm of the right hepatic artery, which caused haemobilia after cholecystectomy. The pseudoaneurysm was successfully eliminated with a stent graft after embolization had failed. Stent grafts should be considered a minimal invasive and effective alternative after failed embolization of a pseudoaneurysm.
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Affiliation(s)
- Amber C Traa
- Department of Surgery, Gelderse Vallei Hospital, Ede, the Netherlands.
| | | | - Arjen L Diederik
- Department of Radiology, Gelderse Vallei Hospital, Ede, the Netherlands
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10
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Xu QD, Gu SG, Liang JH, Zheng SD, Lin ZH, Zhang PD, Yan J. Inferior pancreaticoduodenal artery pseudoaneurysm in a patient with calculous cholecystitis: A case report. World J Clin Cases 2019; 7:2851-2856. [PMID: 31616702 PMCID: PMC6789396 DOI: 10.12998/wjcc.v7.i18.2851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/26/2019] [Accepted: 08/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pancreaticoduodenal artery (PDA) aneurysms are extremely rare. The complicated clinical presentations and high incidence of rupture make it difficult to diagnose and treat. PDA pseudoaneurysms often rupture into the gastrointestinal tract and result in life-threatening gastrointestinal hemorrhage.
CASE SUMMARY A 69-year-old man was admitted to our hospital due to right upward abdominal pain. A computed tomography (CT) scan demonstrated acute cholecystitis and cholecystolithiasis. Percutaneous gallbladder drainage was performed subsequently. He was discharged after 3 d and readmitted to hospital for cholecystectomy as arranged 1 mo later. A repeat CT scan revealed an emerging enhancing mass between the pancreatic head and the descending duodenum. Then, he suffered hematochezia and hemorrhagic shock suddenly. Emergency percutaneous angiogram was performed and selective catheterization of the superior mesenteric artery demonstrated a pseudoaneurysm in the inferior PDA. Coil embolization was performed and his clinical condition improved quickly after embolization and blood transfusion. He underwent laparoscopic cholecystectomy and was discharged from hospital after surgery under satisfactory conditions.
CONCLUSION PDA pseudoaneurysms are uncommon. Acute haemorrhage is a severe complication of pseudoaneurysm with high mortality which clinicians should pay attention to.
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Affiliation(s)
- Qiao-Dong Xu
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Song-Gang Gu
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Jia-Hong Liang
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Shao-Dong Zheng
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Zhi-Hua Lin
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Pei-Dong Zhang
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
| | - Jiang Yan
- Department of Biliary-Pancreatic Minimally Invasive Surgery, The First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
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11
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Proença AL, Veloso Gomes F, Costa N, Bilhim T, Luz JH, Coimbra É. Transarterial Embolization of Iatrogenic Cystic Artery Pseudoaneurysm. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2019; 27:115-118. [PMID: 32266308 DOI: 10.1159/000501400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/07/2019] [Indexed: 12/26/2022]
Abstract
Cystic artery pseudoaneurysm (CAP) is a rare entity most often resulting from inflammatory conditions (acute cholecystitis or pancreatitis) or iatrogenic trauma (cholecystectomy). We report the case of a 73-year-old female who presented with abdominal pain and gastrointestinal bleeding after an episode of acute cholecystitis and endoscopic retrograde cholangiopancreatography for choledocolithiasis removal. Computed tomography and angiography revealed a CAP measuring 5 cm. A right hepatic artery transcatheter embolization was performed with glue, excluding the pseudoaneurysm. The next day, the patient underwent open cholecystectomy with ligation of the cystic artery. Later, ischemic hepatitis and abscess developed.
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Affiliation(s)
- Ana Luísa Proença
- Interventional Radiology Unit, Hepato-Biliary-Pancreatic and Transplant Center, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal
| | - Filipe Veloso Gomes
- Interventional Radiology Unit, Hepato-Biliary-Pancreatic and Transplant Center, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Nuno Costa
- Interventional Radiology Unit, Hepato-Biliary-Pancreatic and Transplant Center, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Tiago Bilhim
- Interventional Radiology Unit, Hepato-Biliary-Pancreatic and Transplant Center, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - José Hugo Luz
- Interventional Radiology Unit, Hepato-Biliary-Pancreatic and Transplant Center, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal.,NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Élia Coimbra
- Interventional Radiology Unit, Hepato-Biliary-Pancreatic and Transplant Center, Hospital Curry Cabral, Centro Hospitalar Lisboa Central, Lisbon, Portugal
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12
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Cao YH, Xu D, Ling TS, Xing YM, Ding S, Gu L. Hemorrhagic shock secondary to cholecystoduodenal fistula with gallbladder pseudoaneurysm: A case report. Shijie Huaren Xiaohua Zazhi 2019; 27:661-664. [DOI: 10.11569/wcjd.v27.i10.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hemorrhagic shock secondary to cholecystoduodenal fistula (CDF) with gallbladder pseudoaneurysm is very rare.
CASE SUMMARY A middle-aged man presented with uncontrolled hemorrhage of the upper gastrointestinal tract. A subsequent diagnosis of rupture of gallbladder pseudoaneurysm secondary to cholecystoduodenal fistula was made. After active treatment, the patient was rescued successfully.
CONCLUSION Most of CDF cases are caused by cholelithiasis and difficult to diagnose early. The joint application of B-mode ultrasonography, computed tomography, magnetic resonance cholangiopancreatography, gastroscopy, and endoscopic retrograde cholangio-pancreatography could improve early diagnosis rate, and digital subtraction angiography can be used in the treatment of CDF with active bleeding. The therapeutic principle of CDF is cholecystectomy, removing calculus, and cutting off and repairing fistula.
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Affiliation(s)
- You-Hong Cao
- Department of Gastroenterology, Gaogu Branch, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 211300, Jiangsu Province, China
| | - Dong Xu
- Department of General Surgery, Gaogu Branch, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 211300, Jiangsu Province, China
| | - Ting-Sheng Ling
- Department of Gastroenterology, Gaogu Branch, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 211300, Jiangsu Province, China,Department of Gastroenterology, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 210008, Jiangsu Province, China
| | - Yi-Ming Xing
- Department of Gastroenterology, Gaogu Branch, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 211300, Jiangsu Province, China
| | - Song Ding
- Department of Gastroenterology, Gaogu Branch, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 211300, Jiangsu Province, China
| | - Lei Gu
- Department of Gastroenterology, Gaogu Branch, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing 211300, Jiangsu Province, China
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13
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Sada DM, Metwalli ZA. Cystic Artery Hemorrhage after Cholecystostomy Catheter Exchange Treated with Transcatheter Embolization. Semin Intervent Radiol 2019; 36:108-110. [PMID: 31123381 DOI: 10.1055/s-0039-1688429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The pathogenesis of formation of cystic artery pseudoaneurysms is not well understood, but is thought to result from erosion of the cystic artery wall from the adjacent inflammatory process associated with acute or chronic cholecystitis. The presented case discusses an incident of hemorrhage from a cystic artery pseudoaneurysm resulting in a large perihepatic hematoma as well as hemobilia, which developed after a routine cholecystostomy catheter exchange. This was treated with transcatheter embolization using ethylene-vinyl alcohol copolymer.
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Affiliation(s)
- David M Sada
- Diagnostic and Therapeutic Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas.,Department of Radiology, Baylor College of Medicine, Houston, Texas
| | - Zeyad A Metwalli
- Diagnostic and Therapeutic Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas.,Department of Radiology, Baylor College of Medicine, Houston, Texas
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14
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Kim DH, Kim TH, Kim CW, Chang JH, Han SW, Kim JK, Lee SH, Kim J. A Ruptured Cystic Artery Pseudoaneurysm with Concurrent Cholecystoduodenal Fistula: A Case Report and Literature Review. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2018. [DOI: 10.7704/kjhugr.2018.18.2.135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Dong Hwi Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Tae Ho Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Chang Whan Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jae Hyuck Chang
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Sok Won Han
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jae Kwang Kim
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Seung Hwan Lee
- Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
| | - Jeana Kim
- Department of Hospital Pathology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
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